Denied :-(

[serenity55 15]

Well, it’s official, I was denied, because I didn’t have the six months’ attempt at losing weight. Before that it was that I didn’t have five years’ proof, or the psych eval. I’m really depressed and feeling like there’s no one to help me. Pacificare, or at least the physicians’ group I deal with, gives me reasons, one at a time. I know that if I really want this I’ll have to keep fighting, but right now it really sucks! I know that I can appeal, and I know that I will, but I’m just so sad right now.

[adamsmom 4]

So sorry to hear this, but don' t dispair. Pick yourself upand try again. You can do this. Good luck!

[aprilapple 1]

Oh honey, I am so sorry. Please keep fighting for what you want.

[serenity55 15]

Thank you adamsmom and April. I know I'll keep fighting, my best friend tells me I'm a true Capricorn, stubborn, and a climber, whatever that means. I'm just not used to going for something like this that I really want. But I must really want to be banded, otherwise why would I be so upset?

Thanks again, to both of you.

[Guest BikiniBeachy]

I'm so sorry. I am on my third insurance company and I started this process in March. It has been heartbreaking and painstaking, but just keep trying. Denial is painful and I'm right there with you. :tongue: Good luck.

[serenity55 15]

Thank you, BikiniBeachy. I called the insurance company, well, actually, i think the woman I talk to is sort of a liaison between my employer and Pacificare. Anyway, she gave me some options: 1. Call my doctor and have her appeal, because, she says, that might carry more weight--no pun intended. 2. Call the member number for Pacificare and have them do the appeal. and 3. I told her about obesity law.com, which she thinks is wonderful. So I'll leave a message for my doctor, maybe go to see her, or maybe I'll just contact obesity law. Like you, I've been doing this since March, and while I know that many people deal with this crap for much longer, I don't want to if I don't have to.

Debbie

[Guest BikiniBeachy]

ANy news Serenity/>????

[serenity55 15]

Bikini Beachy, thanks for asking. I had an appointment with my doctor this past Tuesday, and the first thing she said to me was that the physicians' group I was with has been sold to another group, so she's resubmitting everything. I'd contacted obesity law and they thought they might be able to help me, but when they learned I hadn't even allowed to see a surgeon, they wrote back to say that I was "caught" between my medical group and the surgeon, or something like that. But I was given the name of a doctor to contact to see if there might be a "fit" by which I guess they mean something could be worked out. I'm not giving up, but boy! this is so frustrating!!!!

[missybelle 1]

Don't get down. I was turned down by a psych eval done by a social worker after going through all the drs appts and tests. This so call social worker/psych evaluator said I was to depressed for the surgery. I didn't give up that was three years ago. I started anew in June and everything went well and I had my surgery oct 14 just 2 days ago. Just remember things happen for a reason. You need to find a dr that has a staff that knows the ins and outs of the insurance companies. They will tell you exactly what you need and won't send in something if they think you will be denied. Good luck. Keep your chin up

[Guest BikiniBeachy]

Missy - I had a insane psych guy too that denied me, but my surgeon luckily did it anyway. He was like 100 years old and he got upset I didn't answer my cell phone when he called me (I thought it was creepy and unprofessional to call me several times a week on my cell phone AFTER my appointment to ask me MORE questions about my life?)

He ended up saying my life was too "chaotic". My surgeon was great and said, "That's how your twenties are supposed to be!"

I wish I had gone to someone I had researched that wasn't a super weirdo. He even made me do ink blots...

[serenity55 15]

Missybelle, thank you. It's really easy for me to get down and ask myself why I'm fighting so hard, but when I'm in the place I am now, just waiting, it's just as easy to feel hopeful. There's part of me that simply will not give up, even though I ask myself just what I think I'm doing.

Bikini Beachy, that was kind of creepy for the psych doctor to call you on your cell. My doctor was a little strange too, but my doctor read his report to me, and basically it said that I could benefit from getting the lap band.

Thanks again to you both.

Debbie

[salena4974 0]

Hello, What is obesit law?Thx

[serenity55 15]

Obesity law is an organization that helps people who have been denied WLS, and are appealing. (They also deal with discrimination, and probably other things, too. Anyway, their website is obesitylaw.com. I've read quite a few posts on this site from people who have been successful in getting approval for lap band surgery.

(There may be someone else who can explain what they do a little better than I have.) :-)

Edited October 18, 2008 by serenity55